Predictors for surgical treatment in male patients with non-neurogenic lower urinary tract symptoms (LUTS).

OBJECTIVE: This study aimed to identify clinical and biochemical predictors for future surgical intervention in male LUTS patients. MATERIALS AND METHODS: In a prospective cohort study, parameters as International Prostate Symptom Score (IPSS) and IPSS "bother question" (IPSS-BQ), prostate volume (PV), maximal urine flow (Qmax), Prostate specific antigen (PSA), post-voidal residual urine (PVR) were assessed alongside comorbidities quantified using Charlson Comorbidity Index without age adjustment and American Society of Anesthesiology (ASA) score. For the statistical analysis, patients were categorized based on subsequent treatment approaches: Group 1: underwent surgery during follow-up; Group 2: received medical or no treatment. T-test was used to test differences between the groups. Logistic regression models were used to identify independent predictors of the need for future surgery. Following this analysis, we calculated the probability of requiring surgical intervention, with this likelihood being determined based on the accumulation of identified predictive factors. RESULTS: Of 63 patients, 22 underwent surgery over a median follow-up of 42 months. Significant baseline differences were observed in IPSS (p = 0.003), International Prostatic Symptom Score-Voiding subscore (IPSS-VS) (p = 0.002), IPSS-BQ (p = 0.001), Qmax (p = 0.007), and PVR (p = 0.02) between the groups. Higher IPSS-BQ, IPSS-VS, and lower Qmax are emerging as independent surgical treatment predictors in logistic regression analyses. CONCLUSION: The study identified IPSS-VS, IPSS-BQ, and Qmax as baseline predictors of future surgical intervention. A clear pattern of a gradual increase in the likelihood of requiring surgery was directly proportional to the cumulative number of these identified predictive factors.

Intestinal Obstruction as Initial Presentation of Idiopathic Portal and Mesenteric Venous Thrombosis: Diagnosis, Management, and Literature Review.

It is quite common for portal vein thrombosis to occur in subjects who present predisposing conditions such as cirrhosis, hepatobiliary malignancies, infectious or inflammatory abdominal diseases, or hematologic disorders. The incidence of idiopathic portal vein thrombosis in non-cirrhotic patients remains low, and despite the intensive workup that is performed in these cases, in up to 25% of cases, there is no identifiable cause. If portal vein thrombosis is untreated, complications arise and include portal hypertension, cavernous transformation of the portal vein, gastroesophageal and even small intestinal varices, septic thrombosis, or intestinal ischemia. However, intestinal ischemia develops as a consequence of arterial thrombosis or embolism, and the thrombosis of the mesenteric vein accounts for about 10% of cases of intestinal ischemia. Although acute superior mesenteric vein thrombosis can cause acute intestinal ischemia, its chronic form is less likely to cause acute intestinal ischemia, considering the possibility of developing collateral drainage. Ileus due to mesenteric venous thrombosis is rare, and only a small number of cases have been reported to date. Most patients experience a distinct episode of acute abdominal pain due to ischemia, and in the second phase, they develop an obstruction/ileus. Acute superior mesenteric venous thrombosis is a rare condition that is still associated with a high mortality rate. The management of such cases of superior mesenteric venous thrombosis is clinically challenging due to their insidious onset and rapid development. A prompt and accurate diagnosis followed by a timely surgical treatment is important to save patient lives, improve the patient survival rate, and conserve as much of the patient's bowel as possible, thus leading to fewer sequelae.

Identifying possible biomarkers of lower urinary tract symptoms using metabolomics and partial least square regression.

INTRODUCTION: The objective of this study was to explore potential novel biomarkers for moderate to severe lower urinary tract symptoms (LUTS) using a metabolomics-based approach, and statistical methods with significant different features than previous reported. MATERIALS AND METHODS: The patients and the controls were selected to participate in the study according to inclusion/exclusion criteria (n = 82). We recorded the following variables: International prostatic symptom score (IPSS), prostate volume, comorbidities, PSA, height, weight, triglycerides, glycemia, HDL cholesterol, and blood pressure. The study of 41 plasma metabolites was done using the nuclear magnetic resonance spectroscopy technique. First, the correlations between the metabolites and the IPSS were done using Pearson. Second, significant biomarkers of LUTS from metabolites were further analysed using a multiple linear regression model. Finally, we validated the findings using partial least square regression (PLS). RESULTS: Small to moderate correlations were found between IPSS and methionine (-0.301), threonine (-0.320), lactic acid (0.294), pyruvic acid (0.207) and 2-aminobutyric-acid (0.229). The multiple linear regression model revealed that only threonine (p = 0.022) was significantly associated with IPSS, whereas methionine (p = 0.103), lactic acid (p = 0.093), pyruvic acid (p = 0.847) and 2-aminobutyric-acid (p = 0.244) lost their significance. However, all metabolites lost their significance in the PLS model. CONCLUSION: When using the robust PLS-regression method, none of the metabolites in our analysis had a significant association with lower urinary tract symptoms. This highlights the importance of using appropriate statistical methods when exploring new biomarkers in urology.

Perioperative Management of Patients with Pancreatic Cancer - the ERAS Protocols.

Background: Pancreatic cancer represents the fifth leading cause of death in industrialized countries. The prognosis is reserved, surgical resection being the only curative treatment, but the complications associated bear important impact on the patients survival, prognosis, and quality of life. The ERAS protocols come to meet these shortcomings for enhanced recovery after major pancreatic resections. Material and method: A systematic review was performed following the guidelines outlined by The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Original articles published in the online databases Pubmed (Medline), Embase and Cochrane since 2017 until 2022 were screened after using specific keywords. Results: A total of 252 studies was obtained by searching through online databases. Following the exclusion criteria, we included 7 studies in the systematic review. Conclusions: The ERAS protocols are safe to be applied in the common practice. They are efficient in the perioperative management of patients undergoing pancreatic resections. They can further decrease hospitalization stay, promote better recovery of gastrointestinal function, and speed up postoperative recovery.

IPSS "bother question" score predicts health-related quality of life better than total IPSS score.

OBJECTIVE: The objective of this study was to investigate the role of bothersomeness of urinary symptoms on the general health-related quality of life (HRQoL) of patients with benign prostatic hyperplasia. We hypothesised that a higher International Prostate Symptom Score (IPSS) would be associated with a higher score on the IPSS bother question (IPSS-BQ), and a higher IPSS-BQ score would be the dominant factor associated with poorer general HRQoL. MATERIALS AND METHODS: A case-control, cross-sectional study design was used. Patients were selected according to strict inclusion and exclusion criteria and stratified by IPSS severity group (controls: IPSS < 8; moderately symptomatic: IPSS = 8-18; and severely symptomatic: IPSS > 18). The IPSS-BQ was used to analyse bothersomeness of urinary symptoms. A standardised, multidimensional measure of HRQoL (RAND-36) was used. Data were collected on prostate size, uroflowmetry parameters, prostate specific antigen and comorbidities that were quantified using the Charlson Index and the American Association of Anaesthesiologists (ASA) score. Multiple linear regression models were used to assess the impact of bothersomeness of urinary symptoms on physical and mental HRQoL. Cohen's d was used to determine the effect size. RESULTS: We included 83 patients in the statistical analysis. Linear regression analyses showed that the IPSS was not an independent predictor of HRQoL. Only the highest IPSS-BQ score was associated with both worse physical (P = 0.021) and mental (P = 0.011) HRQoL in the final model. The effect sizes were small to moderate. CONCLUSION: The IPSS-BQ score is an important predictor of HRQoL. The IPSS-BQ score as a proxy should be regarded as a standard outcome measure and reported in all LUTS-related research.

Spatiotemporal complexity of fibroblast networks screens for Alzheimer's disease.

Drugs to treat Alzheimer's disease (AD) have been unsuccessful in preventing its devastating cognitive deficits and progressive neurodegeneration. The lack of a definitive diagnostic for AD has been a major obstacle to AD drug discovery. Here, we describe a novel, highly accurate peripheral diagnostic for AD patients based on quantitatively measured complexity of skin-sampled fibroblast networks. A significant number of samples were studied under double-blind conditions and had autopsy and/or genetic validation. An additional sample confirmed the diagnostic discrimination on freshly obtained skin samples. A sub-sample of these diagnostic differences were induced by oligomerized amyloid-ß1-42. Based on the accuracy of these measures that utilize physical principles such as fractal dimension and lacunarity as well as the significant correlation with disease duration, this biomarker profile appears to identify accurately AD patients for therapeutic intervention.

Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer.

AIM: To identify the risk, the host-related prognostic factors and their predictive value for anastomotic leakage after colorectal resections following cancer. METHOD: 993 patients who underwent large bowel resection and primary anastomosis above 12 centimeters from the anal verge, without a temporary or permanent stoma at the Surgical Hospital No.3 (Cluj-Napoca, Romania) were retrospectively reviewed. RESULTS: 32 (3.22 percent) anastomotic leaks were confirmed. Univariate analysis showed that the preoperative variables significantly associated with anastomotic leakage included: weight loss, smoking, cardiovascular disease, lung disease, hypoproteinemia, diabetes, anemia, leukocytosis, presence of two or more underlying diseases. Alcohol use, cerebrovascular disease, bowel preparation, type of anastomosis, tumor location, stage and histology were not significant variables. Hypoproteinemia (total serum protein level < or = 6 g/dl) and anemia (serum hemoglobin level < or = 11 g/dl) remained significant in the logistic regression model. The prognostic role of serum hemoglobin and proteins for the anastomotic leak was assessed using ROC curve analysis. For the cut-off value of serum protein level = 5.5 g/dl, a sensitivity of 61.6 percent and a specificity of 84.2 percent were calculated. The area under the curve was 0.703 (p= 0.0024). The area under the curve for serum hemoglobin was 0.616 (p=0.028). A sensitivity of 64.0 percent and a specificity of 64.7 per cent were obtained for a cut-off value of 9.4 g/dl. CONCLUSION. A serum protein level lower than 5.5 g/dl and serum hemoglobin lower than 9.4 g/dl could be considered as host-related predictive markers for anastomotic leak in large bowel resections for cancer.

Thoracoscopy: origins revisited.

The ways in which thoracoscopy has evolved wonderfully illustrate how a diagnostic and therapeutic technique can transcend a particular medical or surgical subspecialty. In this review, an in-depth history is provided to enable readers to better understand the nature of minimally invasive endoscopic pleural imaging techniques.

Estimación de los costos totales y parciales de diagnóstico: tratamiento quirúrgico y seguimiento de la hidatidosis hepática en el Hospital San Juan de Dios Santiago Chile 1990-1999 / Estimation of the total and partial costs of diagnosis, surgical treatment and follow up of the liver hydatidosis in the Hospital San Juan de Dios, Santiago, Chile 1990-1999

La hidatidosis hepática es la forma más frecuente de presentación del estado larval de la taenia Echinococcus granulosus en el hombre y nuestro medio no es la excepción. Esta forma de presentación de la hidatidosis es grave y conlleva una serie de problemas económicos tanto para el paciente como para los servicios de salud, ya que su resolución más frecuente es la quirúrgica. Los gastos económicos son los únicos que podemos establecer como costos de esta enfermedad, ya que la morbilidad y mortalidad, indicadores que han sido empleados hasta la fecha, tienen serias limitaciones por efecto de la subnotificación de casos operados en los hospitales. De acuerdo a estos antecedentes se decidió estudiar los gastos económicos de diagnóstico, procedimientos, fármacos y consultas producidos por las cirugías hidatídicas hepáticas realizadas en la década del 90 en el Hospital San Juan de Dios de Santiago, centro de referencia regional para estas intervenciones. Con este fin se estudiaron las fichas clínicas de 16 casos con el diagnóstico de Hidatidosis hepática operada, y cuyos registros estaban completos. Todos los antecedentes de consultas, exámenes, fármacos, tipos de cirugía, etcétera, fueron valorizados de acuerdo a los valores del sistema básico de salud en Chile, analizando posteriormente los valores por el método estadístico de mediana. Se lograron reunir 16 casos de entre 23 y 71 años, siendo en su mayoría pertenecientes al sector rural. Los pacientes estuvieron hospitalizados entre 6 y 71 días, con una mediana de 17 días. El costo mínimo de un caso alcanzó a $ 617.953 y el máximo a $ 3.147.373, con un costo total de $ 1.117.450, equivalente a USA $ 1.591. Este valor correspondió a la mediana del total de casos de hidatidosis hepática. Los costos de exámenes generales fueron los más altos seguidos por la TAC y los menores correspondieron a los exámenes bacteriológicos. De acuerdo a estos antecedentes la hidatidosis hepática en nuestro medio frecuentemente tienen un valor cercano a los 1.600 dólares en su tratamiento. De acuerdo a la prevalencia de la infección y la forma de presentación clínica más frecuente de ella, las autoridades de salud deberían incrementar los programas de prevención de la patología para evitar el costo económico en salud individual, familiar y social que ella produce

Estimación de los costos totales y parciales de diagnóstico, tratamiento quirúrgico y seguimiento de la hidatidosis pulmonar en el Hospital San Juan de Dios, Santiago, Chile, 1990-1999 / Estimation of the total and partial costs of diagnostic, surgical treatment and follow up of the lung hidatidosis in the hospital San Juan de Dios, Santiago, Chile, 1990-1999

La hidatidosis pulmonar es una patología que requiere generalmente de cirugía para su tratamiento y cuyo costo no ha sido establecido directamente sino que sólo a través de la mortalidad y morbilidad que produce. El presente estudio pretendió establecer los costos económicos que significa la hidatidosis pulmonar en cuanto a diagnóstico, tratamiento y seguimiento en 15 casos atendidos entre 1990 y 1999 en el Hospital San Juan de Dios. Para este propósito las fichas médicas fueron valorizadas de acuerdo a los aranceles FONASA, y los insumos mediante los valores de la Central de Abastecimiento del MINSAL. Los resultados mostraron que la hidatidosis pulmonar tiene una mediana de hospitalización de 22 días, con una mediana de 1 cirugía por paciente, el costo total por pacientee osciló entre US$942 y US$3.839, con una mediana de US$1.683. Al sumar las licencias médicas este costo sube a un total de US$1.848. Los mayores costos están dados por la cirugía propiamente tal, seguido por los exámenesimagenológicos, los cuales además de tener utilidad diagnóstico permiten al médico mejorar su abordaje quirúrgico. De acuerdo a los resultados, la hidatidosis sigue siendo una patología frecuente e importante, no tan solo por el impacto en la salud de las personas, sino también por la carga que implica la enfermedad para el paciente, la familia y los servicios de salud

Lues congénita y efecto prozona / Congenital lues and prozone effect

La sífilis congénita es una patología que va actualmente en aumento. Se produce por el traspaso trasplacentario del Treponema pallidum durante el embarazo, determinando una mayor tasa de abortos, mortinatos, malformaciones y partos prematuros. En Chile la detección se realiza de rutina en el embarazo por medio de pruebas no treponémicas (VDRL, RPR). Existen algunas situaciones que pueden dificultar el diagnóstico de sífilis materna, como es el caso del efecto prozona, en que debido a un exceso de anticuerpos no se produce reacción y por lo tanto el resultado es falsamente negativo. Se presenta el caso de un lactante que debutó con lesiones perianales y neurosífilis, con screening negativo de la madre durante el embarazo